Effectiveness of anti-overdose drug Narcan debated

One of the initiatives Gov. Deval Patrick announced in his March declaration of a health emergency of opiate abuse was to increase distribution of an antidote effective at reversing drug overdoses.

Under the plan, Narcan, a brand name of the generic drug naloxone, will be distributed to first-responders, including police and emergency medical technicians, as well as friends and families of known addicts.

"The governor has heard from treatment centers, families and law enforcement that it is really reaching epidemic levels," Health Department spokesman Alec Loftus said. "There are important things that have come on the market lately, like Narcan, where, in the event of someone having an overdose, it can be used."

But the anti-overdose drug -- like the crisis it is being used to fight -- is not new.

Boston EMTs have used an injectable version of the drug since 1978. Other emergency departments have used it since the 1980s. The state Department of Public Health launched a pilot program in 2007 to train civilians in eight communities to use a nasal-spray version of the drug.

No one disputes Narcan's lifesaving power -- the nasal-spray version has reversed 236 overdoses in Quincy since its police department became one of the first in the nation to use the spray in 2010.

But even proponents say it is a temporary remedy that has little impact on the soaring rates of opiate addiction in Massachusetts and the nation.

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"That's not treatment -- that's just stopping someone from dying," says Lee Dalphonse, vice president of Seven Hills, a Worcester-based drug treatment center. "So, now they didn't die, but where's their treatment?"

Opioids, such as heroin, depress the brain's central nervous system. Too much of a drug depresses the brain to the point that the individual stops breathing and passes out.

Narcan, marketed by Endo Pharmaceuticals, the maker of Percocet, a widely abused oxycodone drug, knocks the opioids out of the brain's receptors, reversing the overdose and allowing oxygen to flow back to the brain.

"If I saw anyone passed out on the street, the first thing I would do is administer nasal Narcan," said Jessica Burgess, assistant director for health services at the Barnstable County Sheriff's Department. "It might solve the problem."

John Strang and Michael Farrell, researchers at London's National Addiction Center, suggested its use in a 1992 British Medical Journal article.

"Perhaps a case can be made for distributing ampoules of the opiate antagonist naloxone," they wrote. "Its potential for abuse is nil, the risks are probably minimal, and considerable benefit may accrue if drug users could give emergency doses of (the) antagonist to fellow injectors who inadvertently overdose."

But the drug has drawbacks.

"If you give Narcan to someone with underlying respiratory problems and you wake them up too fast, they become violent or agitated," said Susan Schiller, a watch commander with Boston Emergency Management Services.

Schiller said if an overdose victim has taken other drugs, using Narcan can clear the heroin out of the user's system, magnifying the effects of the other drugs.

"EMTs are trained to look for these underlying issues," Schiller said. "It's actually less ideal to find somebody who hasn't been breathing at all and just give them a shot of Narcan."

Lt. Patrick Glynn, who heads the Quincy Police Department's anti-drug unit, said the department had dealt with overdoses for years, but the problem didn't get as much attention until the Department of Public Health introduced its Narcan-dispensing pilot program.

And while Narcan has saved lives, he tells a cautionary tale that illustrates how the drug is only a temporary stopgap.

Glynn said the department became involved in the DPH's pilot program after the overdose of a Quincy teenager who was successfully revived by EMTs. The teen eventually relapsed and died several years later.

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